Abstracts
1998 Digestive Disease Week

#1019

MAGNETIC RESONANCE IMAGING (MRI) WITH MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP) PREDICTS RESECTABILITY AND DUCTAL ABNORMALITIES IN BENIGN AND MALIGNANT PANCREATIC DISEASE. S.N. Hochwald, M. Dobryansky, N. Rofsky, P. Shamamian, S.G. Marcus New York University Medical Center, New York, New York.

Purpose: Prior to surgical intervention, direct visualization of the pancreaticobiliary ductal system with current non-invasive imaging has limited applicability, due to poor resolution. We evaluated the accuracy of MRI/MRCP in the preoperative evaluation of patients with pancreatic disease. Methods: Patients with a final diagnosis of pancreatic malignancy (n=17: 13 head, 3 body, 1 tail) and chronic pancreatitis (n=6) underwent MRI/MRCP evaluation prior to surgical intervention. Results from this study were correlated with operative findings and pathology in all patients and with ERCP (n=8) and/or PTC (n=3) in 9 patients. The accuracy of MRI/MRCP in identifying the presence of a malignant mass, determining resectability and in identifying biliary and pancreatic duct abnormalities was determined. Unresectable tumors were defined as having local vessel invasion or presence of distant metastases. Results: In 17 of 17 patients with a pancreatic malignancy, MRI/MRCP correctly identified the presence of a pancreatic mass. MRI/MRCP predicted resectability in 16 of 17 (94%) patients. Thirteen patients who were considered resectable by MRI/MRCP successfully underwent resection. Four patients were not resected due to local invasion (n=2) or distant metastases (n=2). MRI/MRCP correctly predicted 3 of these patients to be unresectable, however, incorrectly considered one patient resectable (false negative) who had peritoneal implants at laparotomy. For predicting resectability, MRI/MRCP had a sensitivity of 94%, specificity of 100% and accuracy of 94%. In patients with chronic pancreatitis, MRCP findings correlated well with operative findings, with 4 patients having predominantly pancreatic duct and 2 patients having common bile duct pathology. In one patient with chronic pancreatitis, MRI/MRCP incorrectly identified a pancreatic malignancy. MRCP provided equivalent or superior resolution of ductal anatomy compared to ERCP/PTC. Conclusions: MRI with MRCP is an accurate, non-invasive technique allowing direct visualization of the pancreatico-biliary tree in benign and malignant pancreatic disease. Information obtained from MRI/MRCP including identification of a mass and predicting tumor resectability may be of value in patients with a pancreatic neoplasm. Use of MRCP in addition to MRI may obviate the need for invasive ductal imaging during diagnostic evaluation in these patients.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.